[Prevention of nosocomial pneumonia. Control of endogenous flora. Technique and evaluation]
1Réanimation polyvalente, hôpital Saint Joseph, Paris.
Abstract:
Endogenous infection is considered nowadays as the main factor in the pathogenesis of nosocomial infection. Micro aspirations of hyperseptic secretions coming from the stomach or from the oropharynx is probably responsible for most of nosocomial pneumonia. Theoretical possibilities to reduce nosocomial pneumonia are: 1) reduce the adherence of micro organisms to the bronchi. 2) increase hygienic measures. 3) use topical antibiotics in the oropharynx and the gut (selective digestive decontamination). 4) avoid anti-acids and H2 blockers. 5) avoid inappropriate sedation. 6) increase defenses of the patients against infection. 7) use anti-endotoxins and other type of immunotherapy. All those therapy are to be tested very carefully.
Insights
Endogenous infections drive nosocomial infections, particularly pneumonia, through micro-aspiration. Strategies to prevent this include reducing microbial adherence and enhancing patient defenses.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Context:
- Nosocomial infections, particularly pneumonia, are often caused by endogenous pathogens.
- Micro-aspiration of gastric or oropharyngeal secretions is a primary mechanism for nosocomial pneumonia development.
Purpose:
- To explore theoretical strategies for reducing the incidence of nosocomial pneumonia.
- To identify potential interventions targeting the pathogenesis of hospital-acquired pneumonia.
Summary:
- Endogenous infections are the leading cause of nosocomial infections.
- Micro-aspiration of hyperseptic secretions from the stomach or oropharynx is implicated in most nosocomial pneumonia cases.
- Potential preventive measures include reducing microbial adherence, improving hygiene, selective digestive decontamination, avoiding acid suppressants and deep sedation, and enhancing host defenses via immunotherapy.
Impact:
- Highlights key areas for research and clinical testing in preventing nosocomial pneumonia.
- Suggests a multi-faceted approach to combatting hospital-acquired infections.
- Emphasizes the need for careful evaluation of novel therapeutic strategies.
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